England's at-home abortions amid coronavirus should be 'catalyst' for positive change to remain, experts urge

Experts hope the relaxation of at-home abortion services amid the coronavirus pandemic will continue in England once the outbreak has passed.

Abortion is one of the most common procedures among women of a reproductive age.

Demand for the service is thought to have risen across Europe as the coronavirus outbreak brings economic uncertainty, increased exposure to sexual abuse and limited access to contraception.

To uncover how lockdowns may have restricted abortion services, scientists from Johns Hopkins University in Baltimore analysed the procedures carried out across 46 European regions.

Results revealed abortions have been banned or suspended in seven countries, including Hungary, Malta and Poland.

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England, Wales and Scotland have restricted services, however, they have also adopted abortion by telemedicine – when medics supervise the use of termination pills via videoconferencing or telephone consultations.

Women up to 10 weeks pregnant can also have two abortion pills delivered to their home. Controversial legislation ordinarily requires women in England take one of these tablets at a clinic.

Several experts hope the pandemic will act as a “catalyst” for this “positive change to remain” once we return to life as we knew it.

In 2019 alone, more than 207,000 abortions were carried out among women living in England and Wales.

“Abortion is an essential component of women’s sexual and reproductive care,” the John Hopkins scientists wrote in the journal BMJ Sexual & Reproductive Health.

“While extremely safe under recommended procedures, it is responsible for substantial maternal morbidity and mortality when women do not have access to safe abortion care.”

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Amid the pandemic, the scientists worried abortion services would be affected throughout Europe, warning “politics often trumps evidence”.

“With each passing week of political inaction, thousands of women are denied treatment that cannot be postponed and face the prospect of carrying an unwanted pregnancy to term or of undergoing unsafe procedures,” they wrote.

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Amid the coronavirus outbreak, abortions have been banned in six countries – Andorra, Liechtenstein, Malta, Monaco, San Marino and Poland – and suspended in Hungary.

Access is restricted in 12 nations, while 11 regions have cancelled or delayed services for women with coronavirus symptoms or a positive test, including England, Wales and Scotland.

Denmark and the Stockholm region continue to offer telemedicine abortions, while this has been introduced in England, Wales, Scotland, Ireland and France.

France is also allowing women to access the prescribed abortion drug mifepristone from their pharmacy.

Both mifepristone and misoprostol – the second drug in the regimen – can now be delivered by post in England, Wales, Scotland and Georgia, or home delivered in England, Wales, Scotland and Ireland.

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“Altogether, the diversity of pre-COVID-19 rules regulating abortion coupled with inconsistent responses to the COVID-19 crisis has exacerbated a heterogeneous landscape of abortion provision in Europe,” wrote the scientists.

“The lack of a unified policy response to COVID-19 restrictions has widened inequities in abortion access in Europe, but some innovations including telemedicine deployed during the outbreak, could serve as a catalyst to ensure continuity and equity of abortion care.

“We believe these advances, mostly conceived as temporary responses to a health crisis, could serve as catalyst towards ‘liberalising’ abortion provision and that they should become the standard of care.”

In March, authorities in England allowed women who were up to 10 weeks pregnant to take the two abortion pills at home “on a temporary basis”.

Ordinarily, these women are required to go to a registered clinic to take mifepristone, which blocks the hormone that sustains a pregnancy.

Women are then given misoprostol to take between 24 and 48 hours later at home. This causes the womb to contract so the pregnancy can be “passed”.

Campaigners have long lobbied there is no reason why both drugs cannot be taken at home.

Women have previously reported enduring cramps and bleeding on the way back from the clinic after taking mifepristone, with one even having diarrhoea on public transport.

In Wales and Scotland, women are already permitted to take the two pills at home, however, they cannot normally be delivered.

Abortions have only been legal for first-trimester pregnancies in Northern Ireland since April 2020. Amid the pandemic, authorities are allowing misoprostol to be taken at home at up to 10 weeks.

“The abortion telemedicine pathway introduced into England, Scotland and Wales has enabled thousands of women to access safe abortion care during the COVID-19 pandemic,” said Dr Edward Morris, from the Royal College of Obstetricians and Gynaecologists.

“We have seen huge benefits for women arise out of this simple, yet effective, innovation.

“There has been a reduction in waiting times for women who have requested an abortion, visits to clinics have reduced – which has limited the transmission of the COVID-19 virus among both women and staff – and complications related to abortion have decreased.

“We would urge governments to ensure these positive changes remain in place beyond the pandemic.”

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